Always Look for the Silver Lining
- Reverend Rosie Bouch, 61, went to the emergency room with chest pains and was found to have had a “suspected” heart attack, but further findings by doctors revealed stage 1 lung cancer.
- Rosie, a non-smoker, never would have suspected this diagnosis, nor would her medical team. Catching any cancer early, especially lung cancer, gives a much better prognosis, therefore Rosie is quite lucky.
- Smoking is, of course, the primary cause of lung cancer, but non-smokers can, and do, develop this disease, which many people do not realize. Secondhand smoke and environmental pollutants can do a number on your lungs as well.
Rosie, a non-smoker, never would have suspected this diagnosis, nor would her medical team.Read More
Although her doctor also found she was not at risk for a heart attack in the first place, Rosie begs to differ. Regardless of the lack of concrete findings with her heart, Rosie is thankful for battling early stage cancer opposed to the alternative. Catching any cancer early, especially lung cancer, gives a much better prognosis.
Within six weeks of her emergency hospital visit, she was in surgery. We wish Rosie the best with her recovery and the rest of her treatment and healing process. In the meantime, let’s learn more about lung cancer in non-smokers. It’s more common than you think!
Lung Cancer in Non-Smokers
Smoking is, of course, the primary cause of lung cancer, but non-smokers can, and do, develop this disease. Researchers have made progress in understanding the differences between lung cancer in smokers versus non-smokers, says Dr. Ronald Natale, a medical oncologist at Cedars-Sinai Medical Center, and they’re developing targeted treatments that will be able to address the genetic drivers of lung cancer in non-smokers.
Targeted cancer therapy attacks very specific molecules within a tumor that are involved in its growth and spread.
Pembrolizumab (Keytruda) is approved for treating lung cancers that express PD-L1 or Programmed death-ligand 1. This therapy blocks a protein called PD-L1, which hides and protects the tumor from the immune system.
Nivolumab (Opdivo) is approved in combination with Ipilimumab (Yervoy) for the first-line treatment of patients with metastatic non-small cell lung cancer whose tumors express PD-L1 (≥1%) with no EGFR or ALK genomic tumor aberrations.
Learning More About Lung Cancer
When you or someone you love is diagnosed with lung cancer, the news can be overwhelming. There are, however, things to know and questions to ask that can be helpful in planning the best treatment possible for each individual.
Dr. Patrick Forde, a thoracic oncologist at Johns Hopkins Medicine, recently sat down with SurvivorNet to talk about the first steps typically taken after a lung cancer diagnosis.
First, your medical team will stage the cancer with imaging, a CT scan usually and sometimes an MRI and MRI scan of the brain. Then they need to get a sample of the tumor biopsy on which they perform some routine tests, the most important of which is a PD-L1 test, which helps direct the use of immunotherapy, but also more complicated testing looking for gene mutations in the tumor.
“There are two main types of lung cancer, non-small cell lung cancer, which is about 85% of lung cancers, and small cell lung cancer, which is about 15%,” Forde says. “Within that non-small cell category, there’s a subtype called non-squamous adenocarcinoma, and that’s the group of patients for whom genetic testing is very important on the tumor. Genetic testing is looking for mutations in the DNA, in the tumor, which are not present in your normal DNA.”
Dr. Forde says the important questions to ask when you receive a lung cancer diagnosis are:
- Ask about the histology or type of lung cancer
- Ask about the stage of the cancer
- If the cancer is metastatic or stage 4, ask about the genetic mutation results and also the PD-L1 testing
The PD-L1 test is a “simple test” that involves staining a sample of the tumor with a marker for PD-L1. The lab gives the tumor a percent expression score ranging from from zero where none of the cells have PD-L1 expression and up to 100 percent where all of the cells have PD-L1 expression.
“The likelihood of the tumor responding to immunotherapy depends to a degree on the level of expression,” Dr. Forde says. A tumor with 90% expression PD-L1 on the surface is more likely to respond than one that has no expression.
Dr. Forde says that non-smokers, like Rosie, should make sure genetic testing is performed before going directly on immunotherapy.
For the smokers? Experts say that you need to get your lungs checked at 35. If you need help to stop smoking, here are some resources provided by the CDC.